Energy dynamics of the intraventricular vortex after mitral valve surgery
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Abstract
Mitral valve morphology after mitral valve surgery affects postoperative intraventricular flow patterns and long-term cardiac performance. We visualized ventricular flow by echocardiography vector flow mapping (VFM) to reveal the impact of different mitral valve procedures. Eleven cases of mechanical mitral valve replacement (nine in the anti-anatomical and two in the anatomical position), three bioprosthetic mitral valve replacements, and four mitral valve repairs were evaluated. The mean age at the procedure was 57.4 ± 17.8 year, and the echocardiography VFM in the apical long-axis view was performed 119.9 ± 126.7 months later. Flow energy loss (EL), kinetic pressure (KP), and the flow energy efficiency ratio (EL/KP) were measured. The cases with MVR in the anatomical position and with valve repair had normal vortex directionality (“Clockwise”; N = 6), whereas those with MVR in the anti-anatomical position and with a bioprosthetic mitral valve had the vortex in the opposite direction (“Counterclockwise”; N = 12). During diastole, vortex direction had no effect on EL (“Clockwise”: 0.080 ± 0.025 W/m; “Counterclockwise”: 0.083 ± 0.048 W/m; P = 0.31) or KP (“Clockwise”: 0.117 ± 0.021 N; “Counterclockwise”: 0.099 ± 0.057 N; P = 0.023). However, during systole, the EL/KP ratio was significantly higher in the “Counterclockwise” vortex than that in the “Clockwise” vortex (1.056 ± 0.463 vs. 0.617 ± 0.158; P = 0.009). MVP and MVR with a mechanical valve in the anatomical position preserve the physiological vortex, whereas MVR with a mechanical valve in the anti-anatomical position and a bioprosthetic mitral valve generate inefficient vortex flow patterns, resulting in a potential increase in excessive cardiac workload.
Keywords
Vector flow mapping (VFM) Mitral valve surgery Flow energy lossAbbreviations
- CT
Computed tomography
- EL
Energy loss
- KP
Kinetic pressure
- LV
Left ventricle
- LVDd
Left ventricular diastolic dimension
- LVDs
Left ventricular systolic dimension
- LVEF
Left ventricular ejection fraction
- MR
Mitral regurgitation
- MS
Mitral stenosis
- MVP
Mitral valve plasty
- MVR
Mitral valve replacement
- MRI
Magnetic resonance imaging
- PIV
Particle imaging velocimetry
- TTE
Transthoracic echocardiography
- VFM
Vector flow mapping
Notes
Compliance with ethical standards
Conflict of interest
Dr. Keiichi Itatani was an endowed chair of Kitasato University, financially supported by Hitachi-Aloka Medical Co., Ltd. (Oct 2012–Jun 2015). He is also an endowed chair of Kyoto Prefectural University of Medicine, financially supported by Medtronic Japan Inc. (Apr 2016-present). He has a stock option of Cardio Flow Design Inc. The other authors have no conflicts of interest.
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